Background: Malaria remains the leading cause of morbidity and mortality in sub-Saharan Africa, with children under 5 years accounting for 86% of all malaria deaths. For effective control of malaria, WHO recommends rapid diagnosis and effective treatment, insecticide-treated bed nets, and indoor residual spraying. The use of insecticide-treated bed nets has been shown to be the most cost-effective strategy in preventing this infection. However, despite the Roll Back Malaria subsidized and free bed net distribution initiatives in some Africa countries, bed net uptake and usage still remains low in many households.
Aim: This study aimed to investigate household characteristics and child factors that determine bed net ownership and use amongst under-5 children and the effect of its usage on malaria parasitemia in under-5 children in Nigeria.
Methods: Data from a nationally representative sample of 5895 households was obtained from the 36 states and the Federal Capital Territory in the 2010 Nigeria demographic and health survey, with a minimum of 67 households enrolled per state. Appropriate statistical tools were used to identify the characteristics of households that owned a bed net and to examine the association between the households and child-level factors that predict the use of bed net and malaria prevalence among under-5 children within these households.
Results: The rate of households bed net ownership in Nigeria is about 45.5%. About 48.5% of under-5 children in 33.9% of households surveyed, use a bed net during sleep. There was a strong correlation between households ownership and child sleeping under a bed net (r = 0.706, P , 0.001). Acquisition of these bed nets at no cost significantly determined ownership (P , 0.001) but not usage (P = 0.450). Ownership of a bed net was significantly higher in households in rural areas (P = 0.001), poorer households (P = 0.001), households with an under-5 child (P = 0.001), households whose heads were male (P = 0.001), and of lower educational attainment (P = 0.010). There was a greater likelihood of under-5 children sleeping under a bed net in households with two or more under-5 children (odds ratio [OR] 1.26; CI: 1.05-1.66), two or more bed nets (OR 2.03; CI: 1.56-2.66), and in households whose heads were younger ([OR 2.79; CI: 1.65–4.70] for household heads younger than 29 years and [OR 1.6; CI: 1.17–2.19] for those 30-49 years of age), female (OR 1.61; CI: 1.00-2.61), and poorer (OR 1.77; CI: 1.03-3.04), and less likely in households with more than three other (aside from the under-5 children) household members ([OR 0.23; CI: 0.08-0.69] for household with 4–6 family members and [OR 0.20; CI: 0.07–0.61] for households with 7 or more family members). Malaria parasitemia in under-5 children was higher in: households without a bed net (41.9% versus [vs] 34.2%) (P = 0.016), in children who did not sleep under a bed net (39.7% vs 35.0%) (P = 0.292), in poor households compared to middle and rich households (50.5% vs 44.9% vs 25.9%; P = 0.001), and households in rural settlements (42.6% vs 19.6%) (P = 0.001).
Conclusion: Bed net ownership in households in Nigeria is poor and does not translate to usage. Governments and organizations should not just distribute these nets free of charge to households, but also follow up with regular visits and provision of household education to ensure consistent and correct use, especially amongst under-5 children and pregnant women, who are the most vulnerable to infections and complications from malaria.